Cancer patients 3 times more likely to die in-hospital after PCI

A team in the U.K. published research Nov. 30 suggesting cancer patients are at an elevated risk for major bleeding events and in-hospital death following percutaneous coronary intervention (PCI), the most common interventional treatment in patients with coronary heart disease.

The study, led by Mamas Mamas, DPhil, and colleagues at Keele University, is the largest of its kind to date, the authors wrote in the European Heart Journal. Drawing from the Nationwide Inpatient Sample, the trial considered data from 6.6 million PCI admissions in the U.S. over an 11-year period. Around 10 percent of patients reported either a current (1.8 percent) or past (5.8 percent) cancer diagnosis.

“This research is important because there is limited data regarding outcomes of patients undergoing PCI with a current or historical diagnosis of cancer,” Mamas said in a release. “Such patients are often excluded from randomized controlled trials, and cancer history is not captured in national PCI registries. Clinicians are often unsure what the risks of these procedures are in these patients and how best the procedures should be undertaken.”

Mamas and his team applied multivariable analyses to determine the relationship between cancer diagnosis and negative PCI outcomes, including in-hospital mortality and bleeding complications. Among their findings:

  • Patients with current lung cancer saw a nearly threefold increased risk for in-hospital mortality after PCI.
  • A historical diagnosis of lung cancer was associated with a 1.65-fold elevated risk for in-hospital mortality.
  • Patients with colon cancer were three times more likely to experience major bleeding complications post-PCI.
  • Metastatic cancers, irrespective of type, were linked to poorer PCI outcomes.
  • A current diagnosis of breast cancer wasn’t associated with in-hospital mortality or complications.
  • Patients with prostate cancer faced only an increased risk of bleeding, but no increased risk of death.

Mamas said the study suggests PCI treatment should be tailored to individual patients if they have any medical history of cancer.

“Our research found that a concurrent cancer diagnosis during these procedures is not uncommon, and it has an important impact on the clinical outcome of these procedures depending on the type of cancer, presence of metastases and whether the diagnosis is historical or current,” he said.